Thomas Kucera, a diabetic, was feeling weak and having heart palpitations in May 2000, so he asked his wife to drive him to Doctors Medical Center in Modesto.

He went from the emergency room to a patient room, where for a day and a half he was treated for an irregular heartbeat and mild pneumonia. He was then released.

When he subsequently saw the $48,156 bill for the hospital stay, his heart nearly stopped.

"They are way overcharging and causing people to go broke," the 57-year-old Patterson machinist said.

Kucera, who was uninsured, said he had no way to pay the bill and he did not qualify for free care under Stanislaus County's indigent program.

For months, the hospital's collections office sent him bills demanding payment. Then a collection agency for DMC's owner, Tenet Healthcare, sued him in Stanislaus County Superior Court.

In October 2001, a judge ordered him to pay $57,058, including the original bill, $2,064 interest, $6,608 in attorney fees and $230 in court costs, according to court records.

Kucera, who never appeared in court, already had filed for bankruptcy protection.

"Since I didn't have any insurance, since I didn't have any representation, they figured they could step all over this guy and he could do nothing about it," he said.

Kucera is among the 190 former patients sued by Doctors Medical Center in Stanislaus County in 2001. A sampling of cases showed debts from $650 to $486,000.

Allegations of overbilling and fraud are at the heart of federal and state investigations of Tenet Healthcare, the nation's second-largest hospital chain. In addition to DMC in Modesto, Tenet owns Doctors Hospital of Manteca.

This month, the U.S. Justice Department sued Tenet Healthcare for up to $323 million, accusing the company of overcharging Medicare for certain procedures between 1992 and 1998. Medicare officials also are auditing Tenet and other hospital chains to determine if they improperly charged the government for expensive cases called outliers.

Tenet's critics have suggested that the company has exploited the method of calculating hospital bills to boost its revenue.

The Bee asked an expert in health care billing to compare Kucera's bill with similar cases in the state.

John Glynn, principal for J. Glynn & Company of Oakland, said Kucera's was the highest bill in the state for a two-day stay for the same diagnosis and five times the state average. Other bills that high involved hospital stays of 11 days or more.

Glynn said the fair market value for the care was between $4,216 and $6,934. He estimated the hospital's cost at $6,300 and would recommend a payment in the high end of the fair market value.

"This is more of the kind of bill where heroic, lifesaving procedures are going on," he said. "If that had happened here, I would expect him to have been in the hospital longer."

Glynn, whose company reviews bills for health plan administrators, has analyzed hundreds of bills from DMC and other Tenet hospitals and serves as an expert witness in hospital billing cases in court.

"This case is a good example of how their pricing structure really devastates the little guy," Glynn said.

Tenet spokesman Steve Campanini refused to comment on Kucera's bill, calling it a local hospital issue. Catherine Larsen, spokeswoman for DMC, said the hospital resorts to suing only in cases in which patients refuse to pay or do not respond to billing notices.

Bills add up for some

Tales of sizable charges abound among former Doctors Medical Center patients. Some patients lacked adequate insurance to cushion the blow.

Former Modesto resident Charles Maynard amassed $212,000 in bills from three hospital stays, according to court documents. One bill came to $64,000 when, after five days of tests, it was determined that he had hemorrhoids. An insurance mistake left $9,800 unpaid and, even though the insurance company told Maynard that he did not owe, Tenet's collection agents sued him.

Chris Brown of Modesto said he was charged $3,800 after taking his 6-year-old to the emergency room with a broken wrist and the boy was given a temporary cast. The single dad has struggled to make the $300-a-month payments, and even though he has paid $2,200, the hospital charged him $100 interest last month.

John Fleming of Modesto said he was charged $139,000 for a routine hip replacement. He can breathe easy because Medicare and supplemental insurance paid $24,000 to settle the claim.

Tenet officials have said that the overall billing controversy is overblown, because much of the scrutiny has been on "gross charges," which, like sticker prices on cars, are subject to negotiation.

The government and insurers never pay the full amount; they usually pay daily rates for hospital stays, and in complex cases, a percentage of the total.

No mercy for the uninsured

Uninsured people like Kucera, however, are charged the full amount.

And they are in the weakest position to negotiate with a hospital's billing or legal department, said Beth Capell, a consultant for the advocacy group Health Access.

The group is backing legislation to require hospitals to inform patients of their rights and low-cost insurance programs.

"If you walk into a hospital now, they don't have to tell you anything, even if you can't afford to pay," Capell said.

"Here you are, walking in the door of the emergency room, and you don't know what the rules of the game are. A hospital can certainly slip an application for (state-sponsored) Healthy Families in the envelope when it sends you that $23,000 bill."

Glynn said uninsured people like Kucera might have gone to a county hospital, if Stanislaus County still had one.

County hospitals usually charge less, advise patients about low-cost insurance and, in Kucera's case, "certainly would not drive someone into bankruptcy for a bill like this," he said.

In 1997, Stanislaus County closed its Stanislaus Medical Center, formerly called Scenic General, and entered a 20-year contract with DMC to care for indigents.

David Jones, spokesman for the county Health Services Agency, said the county provides counselors in DMC's emergency room to determine if patients are eligible for free care or low-cost insurance for the working poor.

If they are not eligible, DMC's Larsen said, the hospital tries to work out discounts and payment plans to settle the bills.

She said the billing cases that have gone to court represent a small percentage of the hospital's 80,000 admissions each year.

"This is what goes on everywhere in the health care industry," she said. "We provided $26 million in charity care last year and had $32 million in bad debt."

In December, Tenet volunteered to change the policy and charge uninsured patients in line with its managed care contracts in the region. That change is awaiting approval by the federal government.

Kucera said he was never offered a discount or a payment plan.

Brown, a window installer who earns $12 an hour plus bonuses, said he did not qualify for low-cost insurance when his son broke his arm.

His payment plan stretches his budget to the breaking point because $350 is now deducted from his paycheck for his children's insurance and he owes $7,000 to Modesto's Memorial Medical Center, where his wife died two years ago.

He and his two boys moved into a tiny house off an alley in the Airport Neighborhood. This month he is deciding whether to make his payments or replace the engine in his pickup so he can get to work.

"I am so busy raising my two kids -- I am doing all the cleaning, cooking meals and washing clothes -- that I don't have time to fight it," he said.

It is estimated that 16 percent of San Joaquin Valley residents age 64 and younger are uninsured. And it could get worse under Gov. Davis' budget proposal to lower the income eligibility for Medi-Cal.

Kucera now qualifies for indigent care because numbness in one leg renders him unable to work. Eligibility workers determined that he did not have to sell his mobile home, because he rents the space under it.

While waiting for Social Security to kick in, his wife has one unemployment check still coming. He still fears that Tenet may try to take his mobile home.

Maynard and wife, Kathy, said they haggled with the hospital for months over what they said was a $9,800 mistake in their bill, and then they got sued.

The couple contested the lawsuit without a lawyer's help. They prepared for a settlement conference Oct. 30, but two days before the conference a judge awarded the collection agency $12,870, including interest and legal costs. Letters from the agency threaten to attach Maynard's wages and seize his property if he does not pay.

"The lawyer we had talked to said that fighting insurance companies and hospitals is a losing battle," he said.

His bills from DMC included $84,000 for angioplasty to clear a heart artery, $68,000 after he went to the hospital with chest pains -- he did not suffer a heart attack -- and $64,000 after he went to the hospital with rectal bleeding. The latter turned out to be hemorrhoids, which were surgically removed.

While insurance company, hospital and patient haggled over the balance, continued health problems sent Maynard's life into a spiral.

He lost his supervisor's job with a Bay Area semiconductor firm, sold his boat to pay bills and had to sell his house in Modesto.

A car crash last year broke two vertebrae in his neck. He now lives in a trailer in Groveland and is training to be a truck driver; Kathy rents a place in rural Oakdale.

It does not help that Tenet continues to collect on what he considers a bloated hospital bill.

"You know what it's like? There is so much stress and so much stuff going on you almost wish you were dead," Maynard said. "Why should I have to keep going through this?"

Bee staff writer Ken Carlson can be reached at 578-2321 or kcarlson@modbee.com.

Reprinted by permission of Modesto Bee.